Document Type: Original Article

Authors

1 Department of Internal Medicine, School of Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran

2 Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran

3 Department of Internal Medicine, School of Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran

4 Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran

5 Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran

Abstract

Background: The cognitive impairment in patients with generalized epilepsy may affect their social efficiency and quality of life (QOL). The aim of this study is to determine the cognitive dysfunction and related risk factors in patients with generalized epilepsy as compared to patients with non-epileptic neurological disorders.
Methods: In the present descriptive cross-sectional study, the cognitive function was assessed by Montreal Cognitive Assessment (MoCA) test in 62 patients with generalized epilepsy and also 62 patients with non-epileptic neurological diseases who referred to the Neurology Clinic, Semnan University of Medical Sciences, Semnan, Iran. The relationship between cognitive impairment and related risk factors was also investigated. The data were analyzed by SPSS software.
Results: The mean score of MoCA in the patients with generalized epilepsy and the control group was 22.80 ± 4.14 and 26.48 ± 2.85, respectively (P < 0.050). The results indicated significantly lower MoCA scores in the epileptic group rather than the non-epileptic one (P < 0.001). Moreover, there was a significant relationship between MoCA score and age, education level, living place, the dose and rate of medicines, and the number of seizures in patients with epilepsy (P < 0.001). Gender and the duration of disease had no significant effects on the cognitive impairment of patients with epilepsy (P > 0.05).
Conclusion: Patients with epilepsy had a significant cognitive impairment as compared to the patients with non-epileptic neurological disorders. Age, education level, living place, the dose and rate of medicines, and the number of seizures were the risk factors of cognitive impairment in the patients with epilepsy, while duration of disease and gender had no effects on the intensity of cognitive deficits.

Keywords

  1. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2197-223.
  2. Victor M, Ropper AH, Adams RD. Adams and Victor's manual of neurology. New York, NY: McGraw-Hill; 2002.
  3. Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology 2017; 88(3): 296-303.
  4. Bradley WG. Neurology in clinical practice: Principles of diagnosis and management. vol. 1. Philadelphia, PA: Butterworth-Heinemann; 2004.
  5. de Souza EA, Salgado PC. A psychosocial view of anxiety and depression in epilepsy. Epilepsy Behav 2006; 8(1): 232-8.
  6. Bishop M. Barriers to employment among people with epilepsy: Report of a focus group. J Vocat Rehabil 2002; 17(4): 281-6.
  7. Raty LKA, Larsson BMW, Soderfeldt BA. Health-related quality of life in youth: A comparison between adolescents and young adults with uncomplicated epilepsy and healthy controls. J Adolesc Health 2003; 33(4): 252-8.
  8. Salehzadeh M, Kalantari M, Molavi H, Najafi MR, Nouri A. Effectiveness of cognitive-behavioral group therapy with focusing on dysfunctional attitudes in epilepsy on quality of life in intractable epileptic patients. International Journal of Behavioral Sciences 2011; 4(4): 255-60.
  9. Lambert MV, Robertson MM. Depression in epilepsy: Etiology, phenomenology, and treatment. Epilepsia 1999; 40(Suppl 10): S21-S47.
  10. Lopes R, Moeller F, Besson P, Ogez F, Szurhaj W, Leclerc X, et al. Study on the relationships between intrinsic functional connectivity of the default mode network and transient epileptic activity. Front Neurol 2014; 5: 201.
  11. Zhao F, Kang H, You L, Rastogi P, Venkatesh D, Chandra M. Neuropsychological deficits in temporal lobe epilepsy: A comprehensive review. Ann Indian Acad Neurol 2014; 17(4): 374-82.
  12. Schouten A, Oostrom KJ, Pestman WR, Peters AC, Jennekens-Schinkel A. Learning and memory of school children with epilepsy: a prospective controlled longitudinal study. Dev Med Child Neurol 2002; 44(12): 803-11.
  13. Eddy CM, Rickards HE, Cavanna AE. The cognitive impact of antiepileptic drugs. Ther Adv Neurol Disord 2011; 4(6): 385-407.
  14. Pressler RM, Binnie CD, Coleshill SG, Chorley GA, Robinson RO. Effect of lamotrigine on cognition in children with epilepsy. Neurology 2006; 66(10): 1495-9.
  15. von Stulpnagel C, Kluger G, Leiz S, Holthausen H. Levetiracetam as add-on therapy in different subgroups of "benign" idiopathic focal epilepsies in childhood. Epilepsy Behav 2010; 17(2): 193-8.
  16. Realmuto S, Zummo L, Cerami C, Agro L, Dodich A, Canessa N, et al. Social cognition dysfunctions in patients with epilepsy: Evidence from patients with temporal lobe and idiopathic generalized epilepsies. Epilepsy Behav 2015; 47: 98-103.
  17. Wang L, Chen S, Liu C, Lin W, Huang H. Factors for cognitive impairment in adult epileptic patients. Brain Behav 2020; 10(1): e01475.
  18. Natham R, Amirthalingam P, Mukunthu N, Arunachalam G. Sensitivity of Montreal Cognitive Assessment in comparison with Mini Mental Status Examination in Testing Cognitive status in epilepsy patients with phenytoin monotherapy. American Journal of Phytomedicine and Clinical Therapeutics 2015; 3(3): 237-44.
  19. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53(4): 695-9.
  20. Miller LA, Galioto R, Tremont G, Davis J, Bryant K, Roth J, et al. Cognitive impairment in older adults with epilepsy: Characterization and risk factor analysis. Epilepsy Behav 2016; 56: 113-7.
  21. Pirscoveanu D, Tudorica V, Zaharia C, Matcau D, Trifan F, Stanca D. Study about cognitive performances in elderly patients with epilepsy. Romanian Journal of Neurology 2010; 9(2):78-81.
  22. Phabphal K, Kanjanasatien J. Montreal Cognitive Assessment in cryptogenic epilepsy patients with normal Mini-Mental State Examination scores. Epileptic Disord 2011; 13(4): 375-81.
  23. You SJ. Cognitive function of idiopathic childhood epilepsy. Korean J Pediatr 2012; 55(5): 159-63.
  24. Mazdeh M, Zarei H, Asgari Mobarakeh K. A comparative investigation of neuropsychological dysfunctions of antiepileptic drugs in epileptic patients. Avicenna J Clin Med 2014; 21(2): 137-44. [In Persian].
  25. Vingerhoets G. Cognitive effects of seizures. Seizure 2006; 15(4): 221-6.
  26. Thompson PJ, Duncan JS. Cognitive decline in severe intractable epilepsy. Epilepsia 2005; 46(11): 1780-7.
  27. Merkena MD (2016) Prevalence of cognitive adverse outcomes in epileptic outpatients. J Neurol Stroke 4(5): 00155.